Provider Demographics
NPI:1336130673
Name:RUGGIERO, VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1207
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-967-6023
Practice Address - Street 1:3333 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3608
Practice Address - Country:US
Practice Address - Phone:718-667-7500
Practice Address - Fax:718-448-0478
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210396-1207X00000X, 207XS0106X
NJMA-61400207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990716Medicaid
G91318Medicare UPIN
NY84G351Medicare PIN